1. Dr. Sayantan Mondal

2.  Overview : Definition
 Extent of Problem , Need, Present practices
 BMW Management Rules and application,
 categories of BMW
 segregation,Transport & storage
 Treatment & Disposal
 Authorization, Reporting of Accidents
 BMW management Committee
 Take Home Message

3. Bio-medical waste" means any waste, which is generated during the
diagnosis, treatment or immunisation of human beings or animals or in
research activities pertaining thereto or in the production or testing of
biologicals,and including categories mentioned in Schedule I;
Biologicals" means any preparation made from organisms or micro-
organisms or product of metabolism and biochemical reactions
intended for use in the diagnosis, immunisation or the treatment of
human beings or animals or in research activities pertaining thereto;
Specific to hospitals Bio-medical waste is defined as waste that is generated
during the diagnosis, treatment or immunization of human beings and are
contaminated with patient’s body fluids (such as syringes, needles,
ampoules ,organs and body parts, placenta, dressings, disposables plastics
and microbiological wastes).

4.  Hospital waste: refers to all waste, biological
or non biological, that is discarded and is not
intended for further use
 Medical waste: refers to materials generated
as a result of patient diagnoses, treatment,
immunization of human beings or animals
4

5.  Infectious waste: are the portion of medical
waste that could transmit an ‘infectious
disease’.
 Pathological waste : waste removed during
surgery/ autopsy or other medical procedures
including human tissues, organs, body parts,
body fluids and specimens along their
containers.
5

6.  Government/private hospitals
 Nursing homes
 Physician/dentist office or clinic
 Dispensaries
 Primary health care centers
 Medical research and training centers
 animal./slaughter houses
 labs/research organizations
 Vaccinating centers
 Bio tech institutions/production units
6

7. What is Biomedical Waste?
Waste Sharps eg: Needles Discarded medicines
Human anatomical waste Solid waste eg: cotton swabs

8. Who’s at Risk ?
• Doctors and nurses
• Patients
• Hospital support staff
• Waste collection and disposal staff
• General public and
• the Environment

9. Non-Infectious
waste, 80%
Pathological
and Infectious
waste, 15%
Chemical and
Pharmaceutical
waste, 3%
Sharps,
1%
Radioactive,
Cytotoxic and
heavy metals,
1%

10. Pharmaceutical Waste
Sharp Waste 10

11. Cytotoxic drugs
Lab reagents
Genotoxic waste
Chemical
waste
11

12. Waste with high content
of heavy metals
Worn out batteries
Blood pressure guages
12

13. 1. Infection
2. Genotoxicity Cytotoxicity
3. Chemical toxicity
4. Radioactivity hazards.
5. Physical injuries
6. Public sensitivity.

14. The infectious agents enter in the body
through
 Puncture,
 Abrasion,
 Cut in the skin;
 Through mucous membranes;
 By inhalation and ingestion.

15. 1. Gastro enteric through faeces and/or vomit
e.g. Salmonella, Vibrio Cholera, Helminthes
Hepatitis A
2. Respiratory through inhaled secretions
e.g. Mycobacterium tuberculosis; measles virus;
streptococcus pneumonae
3.Ocular infections through eye secretions
e.g. Herpes virus,
4. Skin infection through pus
e.g. Streptococcus spp ,
5. Meningitis through Cerebrospinal fluid
e.g. neisseria meningitides,

16. 6. Blood borne diseases
• AIDS
• Septicaemia and bacteraemia
• Viral Hepatitis B & C
7. Hemorrhagic fevers through body fluids
• Lassa, Ebola and Marburg viruses

17. Chemical Toxicity
• Irritant to skin and eyes
E.g. alkylating agent, intercalating agent
• Carcinogenic and Mutagenic
e.g. Secondary neoplasia due to chemotherapy
• Many drugs are hazardous
• May cause intoxication , burns, poisoning on exposure

18. Physical Injuries
Radioactive waste exposure may cause headache, dizziness,
vomiting, genotoxicity and tissue damage
May result from sharps, chemicals and explosive agents
Public sensitivity
Visual impact of the anatomical waste, recognizable
body parts

19. NEED FOR BMW MANAGMENT
 Nosocomial infections to patients from poor
infection control practices and poor waste
management.
 Drugs which have been disposed of, being repacked
and sold off to unsuspecting buyers.
 Risk of air, water and soil pollution directly due to
waste, or due to defective incineration emissions and
ash.
 Risk of infection outside hospital for waste handlers
and scavengers, other peoples.

20.  In the late 1980’s
◦ Items such as used syringes washed up on several East
Coast beaches USA
◦ HIV and HPV virus infection
◦ Lead to development of Biomedical Waste Management
Law in USA.
 However in India the seriousness about the management
came into lime light only after 1990’s.

21.  GLOBALLY- Developed countries generate 1 to 5
kg/bed/day
 Developing countries: meager data, but figures are
lower. 1-2kg/pt./day
 WHO Report: 85% non hazardous waste
: 10% infective waste
: 5% non-infectious but
hazardous. (Chemical,
pharmaceutical and radioactive)
 INDIA:-No national level study
- local or regional level study shows hospitals
generate roughly 1-2 kg/bed/day 21

22.  in 2000
 injections with contaminated syringes caused:
 • 21 million hepatitis B virus (HBV)
 infections (32% of all new infections);
 • Two million hepatitis C virus (HCV)
 infections (40% of all new infections);
 • 260 000 HIV infections (5% of all new)

23. >95,000 hospitals and healthcare facilities in India .
4.2 lakh kg of biomedical waste is generated on a daily basis.
Three million tonnes of medical wastes generated every year.
Expected to grow 8% annually.
2,91,983 kg/day BMW is disposed. which means that almost 28% of the wastes is left
untreated and not disposed finding its way in dumps or water bodies and re-enters our system.
Karnataka tops the chart with 62,241 kg/day of BMW.
 Only 179 CTF to treat the BMW in the country.
No. of HCF/CBWTF violated BMW rules 5472
No. of show cause notice/ Directions issued to defaulter HCE/CBWTF 3585


24. •Around 40% of the hospitals in the
country are dumping the BMW with
Municipal garbage
•Waste is not segregated at the site
• 3585 hospitals have been served
notice for acting as defaulters of
these rules.
•No proper treatment options
•No regulated disposal plan/sites

26. 1. Survey of waste generated.
2. Segregation of hospital waste.
3. Collection & Categorization of waste.
4. Storage of waste.( Not beyond 48 hrs. )
5. Transportation of waste.
6. Treatment of waste.

27. BIOMEDICAL RULES 1998
The Government of India as contemplated under
Section 6,8 and 25 of the Environment (Protection)
Act,1986, has made the Biomedical Wastes
(Management & Handling) Rules, 1998.
The rules are applicable to every institution
generating biomedical waste which includes hospitals,
nursing homes, clinic, dispensary, veterinary
institutions, animal houses, laboratory, blood bank.
The rules are applicable to all persons who
generate, collect, store, transport, treat, dispose,
handle bio medical waste in receive, any form.

28. Approx. Quantity : 4 to 250 liters / bed / day
Sewage from isolation wards,
ICU’s
toilets & urinals, Bed-bath,
bathrooms
and hospital’s laundry
Wash waters from
laboratories,OPD,
Dressing rooms & Operation
theaters.

29. Approximate Quantity : 0.3 to 3.5 kg/bed/day
1.Garbage
55%
(Bulk Density :330 kg/m3,Cal.Value:1000 K.cal / kg, Moisture :40%)
2.Bio-medical waste (sensu stricto) 13%
A. Wasted body remains 05%
(Blood,Cultures,Anotomicals)
B. Pharmaceutical & Chemical Wastes 02%
C. Pathological wastes (may be infectious) 06%
3.Sharp Objects 20%
4.Pressurized Containers & Discarded Instruments 02%
5.Radioactive Wastes
0.3%

30. WASTE CATEGORY TYPE OF WASTE
Category No. 1 Human Anatomical Waste
Category No. 2 Animal Waste
Category No. 3 Microbiology & Biotechnology Waste
Category No. 4 Waste Sharps
Category No. 5
Discarded Medicine and Cytotoxic
drugs
Category No. 6 Soiled Waste
Category No. 7 Solid Waste
Category No. 8 Liquid Waste
Category No. 9 Incineration Ash
Category No.10 Chemical Waste

31. 2011 1998
Every occupier generating BMW,
irrespective of the quantum of wastes
comes under the BMW Rules and requires
to obtain authorisation
Occupiers with more than 1000 beds
required to obtain authorisnatio
Duties of the operator listed Operator duties absent
Treatment and disposal of BMW made
mandatory for all the HCEs
Rules restricted to HCEs with more than
1000 beds
A format for annual report appended with
the Rules
No format for Annual Report
Form VI i.e. the report of the operator on
HCEs not handing over the BMW added to
the Rules
Form VI absent

32. WASTE
CATEGORY
WASTE TYPE TREATMENT & DISPOSAL
Categor
y 1
Human Anatomical waste (human tissues,
organs, body parts
Incineration/deep burial
Categor
y 2
Animal Waste: Animal tissues, organs,
body parts carcasses, bleeding parts,
fluid, blood and experimental animals
used in research, waste generated by
veterinary hospitals, colleges, discharge
from hospitals, animal houses
Incineration/deep burial
Categor
y 3
Microbiology & Biotechnology Wastes:
Wastes from clinical samples, pathology,
biochemistry, hematology, blood bank,
laboratory cultures, stocks specimens of
micro-organisms, live or attenuated
vaccines human and animal cell culture
used in research and infectious agent
from research and industrial
laboratories, waste from production of
biologicals, toxins, dishes and devices
Disinfection at source by
chemical treatment or
by Autoclaving /
Microwaving / followed
by Mutilation /
shredding and after
treatment final disposal
in secured landfills or
disposal of recyclable
waste (plastic or glass )
SCHEDULE I: CATEGORIES OF BIO-MEDICAL WASTE

33. WASTE
CATEGORY
WASTE TYPE TREATMENT & DISPOSAL
Category
No. 4
Waste Sharps (needles, glass
syringes or syringes with fixed
needles, scalpels ,blades, glass
etc.) that may cause puncture and
cuts(Includes both used and
unused sharps).
Disinfection (chemical
treatment / destruction
by needle & tip cutter,
autoclaving/microwave
and
mutilation/shredding
and final disposal
through CBWTF /
landfills
Category
No. 5
Discarded Medicines & Cytotoxic
drugs (Wastes comprising of outdated,
contaminated and discarded
medicines)
Disposal in secured landfills
or Incineration
Category
No. 6
Soiled Waste (Items contaminated with
blood, & body fluids including cotton,
dressings, soiled plaster casts, linens,
beddings, other material contaminated
Incineration

34. WASTE
CATEGORY
WASTE TYPE TREATMENT & DISPOSAL
Category
No.7
Infectious Solid Waste (waste
generated from disposable
items other than the waste
sharps such as tubing's, hand
gloves, saline bottles with IV
tubes, catheters, glass,
intravenous sets etc.
Disinfection by chemical
Treatment / autoclaving
/Microwaving followed
by mutilation /
shredding & final
disposal through
registered recycler
Category
No.8
Chemical Waste ( Chemicals
used in production of
biologicals, chemicals used in
disinfection as insecticides etc.)
Chemical treatment and
discharge into drains for
liquids and secured
landfill for solids

35. NOTE
1. Chemicals treatment using at least 1% hypochlorite solution or
any other equivalent chemical reagent.
2. Mutilation/shredding must be such so as to prevent unauthorized
reuse.
3. There will be no chemical pretreatment before incineration.
Chlorinated plastics should not be incinerated.

36. Colour
coding
Type of
container
Waste
category
Treatment /
Disposal
Non chlorinated
Plastic Bags
Incineration/
Deep Burrial
Non chlorinated
plastic bag /
puncture proof
Container for
sharps
Chemical Treatment /
Autoclaving /
Microwaving and followed
by Mutilation & shredding
and disposal in landfills or
disposal of recyclable
waste
Non chlorinated
Plastic Bags /
Containers
Chemical Treatment
and discharge into drains
for liquids and secured
landfill for solids
Non chlorinated
Plastic Bags
Municipal
waste
Disposed as per the
Municipal Solid Waste

37. BIOHAZARD
SYMBOL
CYTOTOXIC
HAZARD SYMBOL
BIOHAZARD CYTOTOXIC
HANDLE WITH CARE
Note : Lable shall be non-washable and
prominently visible.
Schedule-III
LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS

39. Bio-medical waste shall not be
mixed with other wastes
Bio-medical waste shall be
segregated into containers/bags
at the point of generation in
accordance with Schedule II
 The containers shall be labeled
according to Schedule III.

40. Black Dustbin & Bags
Paper waste, food waste
and other non
infectious wastes
generated from the
hospitals should be
stored in black coloured
bags / containers &
Disposed as per MSW
management rules,
MANAGEMENT OF HOSPITAL WASTE

41. KITCHEN WASTE/FOOD
PAPER/p
lastic
WASTE DISPOSAL
BLACK BIN
For Noninfectious
Solid waste

42. Bandages
Swab stick-
decontaminated
WASTE DISPOSAL
Dressing
soiled linen,
contaminate
d gowns,
drapes
Animal waste
YELLOW BIN
Category 1,2, 5,6

43. RED BINDrains
Plastic culture
plates & tubes
I/V
sets
Urine bag
WASTE DISPOSAL
All infectious waste
sharp, non
sharp & sharps
plastic waste
Category 3, 4, 7
Pathology waste

44. In Blue Nonchlorinated bags
Chemical waste
Chemical Treatment and discharge
into drains for liquids and secured
landfill for solids

48.  In an area away from general traffic and accessible
only to authorized personnel
 DO NOT store for more than 48 hours
 If for any reason it becomes necessary to store the
waste beyond such period take measures to ensure
that the waste does not adversely affect human
health and environment

49.  If a container is
transported from the
premises where bio-
medical waste is
generated to any waste
treatment facility outside
the premises, the
container shall, apart
from the label prescribed
in Schedule III, also carry
information prescribed in
Schedule IV.

50.  Waste category No. Day -------- Month --------
 Waste class Year --------
 Waste description Date of generation-----------
Sender's Name & Address Receiver's Name & Address
 Phone No. ........................... Phone No. ...........................
 Telex No. ............................ Telex No. ............................
 Fax No. ............................... Fax No. ...............................
 Contact Person ................... Contact Person ...................
In Case of Emergency, Please Contact:
 Name & Address
 Phone No.

51.  1.Incineration
 2.Chemical Disinfection
 3.Wet and dry thermal treatment
 4.Microwave irradiation
 5.Land disposal
 6.Inertization

52.  Combustion efficiency (CE) shall be at
least 99.00%.
 The Combustion efficiency is computed
as follows:
 %C02
 C.E. = ------------ X 100
 %C02 + % CO
 The temperature of the primary
chamber shall be 800 +/-500 C
 The secondary chamber gas
residence time shall be at least 1
(one) second at 1050 +/- 500 C
Drawback
toxic products like furanes and dioxins - can cause air pollution

56. Emission Standards
Parameters Concentration mg/Nm3 at (12%CO2 correction)
Particulate matters 150
Nitrogen Oxide 450
HCl 50
Minimum stack height shall be 30 metres above ground
Volatile organic compounds in ash shall not be more than 0.01%

58. A temperature of not
less than 121 0C and
pressure of 15 pounds
per square inch (psi)for
an autoclave residence
time of not less than 60
minutes
Validation test :
Spot testing by Bacillus
stearo-thermophilus
spores on a spores strip
with at least 1 x 104
Spores/ml.
Routine test :
Chemical indicator strip/tape

59. STANDARD FOR MICROWAVING
SHOULD KILL BACTERIA AND OTHER PATHOGENIC
ORGANISM
BIOLOGICAL INDICATOR Bacillus Subtilis
CHEMICAL PROCESSES
Dissolved chlorine dioxide, bleach (sodium hypochlorite),
peracetic acid, or dry inorganic chemicals.
To enhance exposure of the waste to the chemical agent,
chemical processes often involve shredding, grinding, or
mixing.

61.  Every occupier of an institution generating,
collecting, receiving, storing, transporting, treating
and /or handling Biomedical Waste shall apply on
Form 1 for Authorization to the Board.
 The State Pollution Control Board are declared as
prescribed Authority for grant of Authorization.
The Board grants authorizations after satisfying
itself.

62. APPLICATION FOR AUTHORISATION
(To be submitted in duplicate.)
To
The Prescribed Authority
(Name of the State Govt/UT Administration)
Address.
1. Particulars of Applicant
(i) Name of the Applicant
(In block letters & in full)
(ii) Name of the Institution:
Address:
Tele No., Fax No. Telex No.
2. Activity for which authorisation is sought:
(i) Generation
(ii) Collection
(iii) Reception
(iv) Storage
(v) Transportation
(vi) Treatment
(vii) Disposal
(viii) Any other form of handling
3. Please state whether applying for resh authorisation or for renewal:
(In case of renewal previous authorisation-number and date)

63. Form 1- Continued
4.
(i) Address of the institution handling bio-medical wastes:
(ii) Address of the place of the treatment facility:
(iii) Address of the place of disposal of the waste:
5.
(i) Mode of transportation (in any) of bio-medical waste:
(ii) Mode(s) of treatment:
6. Brief description of method of treatment and disposal (attach details):
7.
(i) Category (see Schedule 1) of waste to be handled
(ii) Quantity of waste (category-wise) to be handled per month
8. Declaration
I do hereby declare that the statements made and information given above are
true to the best of my knowledge and belief and that I have not concealed any
information.
I do also hereby undertake to provide any further information sought by the
prescribed authority in relation to these rules and to fulfill any conditions
stipulated by the prescribed authority.
Date : Signature of the Applicant
Place : Designation of the Applicant

64.  Every occupier/operator submit an annual report to
the prescribed authority in Form II by 31 January
every year, to include information about the
categories and quantities of bio-medical wastes
handled during the preceding year. The prescribed
authority shall send this information in a compiled
form to the Central Pollution Control Board by 31
March every year.

65. a. Every authorized person shall maintain records
related to BMW.
b. All records shall be subjected to inspection and
verification by the prescribed authority at any time.
c. In any accidents, the authorized person shall
report the accident in Form III along with the
remedial action taken to the prescribed authority
forth with

66. Setting up a CELL or UNIT for BMW management.
The BMW 2011, Rules have also made mandatory for all the
HCEs with 30 or more beds to set up a cell or unit to deal
with the BMW management. The cell has to meet every six
months and minutes of the meeting have to be submitted
along with the Annual Report to the prescribed authority

67.  Head of the hospital : chairman
 Waste Mx officer (dev. and implementation
plan)
Members:
 HOD’s of all department
 Nursing superintendent,
 Head nurse,
 Sanitary inspector
 Chief pharmacist,
 Radiation officer
 Supply officer,
 financial officer

68.  Day to day control of segregation, transport & disposal of BMW
 Co-ordinate with the store officer for continuous supply of basic
items for BMWM
 Prepare guidelines for BMWM & distribute to all department
 Prepare BMW posters to raise awareness
 Arrange training programmes on BMWM & safety measures for all
categories of HCW
 Co-ordinate with HOD/In-charge of Deptt. where deficiencies are
pointed out
 Co-ordinate with Chhattisgarh Environment Conservation Board )

69. Do’s
 The used product should be segregated
 The used product should be mutilated.
The used product is treated prior to disposal.
 Use protective gear when handling waste
 Collect waste when the bin is 3/4 the full
 Clean spills with disinfectant
 Use trolleys & do not drag waste bags
Do not
 Reuse plastic equipment.
 Mix plastic equipment with other wastes.
 Burn plastic waste.
 Avoid needle stick injuries
 Avoid using common lift to move waste
 Avoid spillage

70.  Waste minimization & recycling of waste
 Identification of points of generation of waste
 Waste segregation at source
 Compiling the inventory of waste
 Waste treatment (disinfection etc.) at the site
 Waste collection and transportation, on-site and off-
site
 Waste treatment , on-site & off the site
 Final disposal of waste
 Occupational safety
 Continuous monitoring of the system
 Training of the staff.
70

72.  Bio-medical waste programme cannot be successfully
implemented without the willingness, self-motivation,
and co-operation from all sections of employees of any
health care setting.
 If we want to protect our environment and health of
community we must sensitize our selves to this
important issue not only in the interest of health
managers but also in the interest of community.